Medication safety in hospitals has been a public concern since the Institute of Medicine released a report in 2006 stating that medication errors harm more than 1.5 million hospitalized patients in the U.S. each year.

At Washington Hospital, physicians, nurses, pharmacists, and other members of the health care team work continuously to make patient care as safe as possible. ItÕs all part of a hospital-wide commitment to building a Òculture of safety.Ó Their efforts include using all available resources, such as the latest information technology, to prevent errors when patients are given their prescribed medications.

In the hospital, the medication administration process is complex, involving numerous steps and different members of the health care team. The process touches every patient in the hospital, since each person takes at least one form of medication. Medications are dispensed in varying doses and on different schedules, according to the patientÕs needs and as prescribed by their physician. Washington HospitalÕs goal is to make the entire procedure, from purchasing to prescription to dispensing and administering the medication, completely safe and error-free.

Last summer, the hospital launched its WeCare electronic health record system. WeCare provides an opportunity to make the challenging process of medication administration more accurate than ever by providing the opportunity to initiate another computerized process called Bar Coding Medication Administration (BCMA).

The BCMA story is highlighted in the most recent issue of Washington Hospital Healthcare SystemÕs Health Signs community magazine. The Fall 2013 issue is the SystemÕs Annual Report to the Community for 2012-2013, soon to be delivered to more than 50,000 homes in the Tri-City area.

ÒMedication safety has long been a top priority at Washington Hospital, and we were pleased to be able to take advantage of the power of WeCare to help make the process of administering medication safe and more accurate for our patients,Ó said Barbara Eusebio, RN, JD, CPHQ, the HospitalÕs chief of quality and resource management.

Guided by the five ÒrightsÓ

In giving medication to patients, Washington Hospital nurses are guided by the five ÒrightsÓ of medication administration: right patient, right time, right medication, right dose, and right route. The BCMA system supports these goals by issuing an alert when potential errors are detected.

At the bedside, before dispensing medication, the nurse uses an automated scanner to scan the patientÕs identification badge. This connects to a database that matches information about individual patient care orders. Based on the scanned information, the system will issue an alert if the medication being offered is not the one prescribed for that patient, or if it is the wrong dosage. The nurse is also alerted if the medication is being offered at the wrong time or the wrong route.

Preparing for the implementation of the bar coding system required extensive planning and preparation by the HospitalÕs staff, including considerable time devoted to the training of nurses, who are the systemÕs end users. Five months after the BCMA system was first activated, work continues with meticulous monitoring, analysis and troubleshooting when issues arise.

Two interdisciplinary groups have led the way: the WeCare team, which is responsible for setting up the electronic health record system, and the Medication Analysis Committee (MAC), chaired by Vandana Sharma, M.D., PhD. This group has oversight of the HospitalÕs medication delivery process, including error reduction and any other safety issues related to medication.

BCMA developed a hospital-wide bar code policy, and proactively tested and analyzed the process to assess for its readiness. This advance work enabled the team to fine-tune the system and add further improvements, such as a mobile pill crusher, so nurses can crush medication at the bedside while scanning and administering medications according to hospital barcode policy. Another improvement was the addition of system keyboards that glow in the dark to keep patient rooms as dim as possible during the night.

BCMA Òwent liveÓ at Washington Hospital in July. During the first month, the MAC team met every day to monitor the system and track and resolve issues as they arose. The goal was to scan as many patients and medications as possible, because every patient who is scanned is assured of receiving medication with the highest level of safety and accuracy. After Ògo-live,Ó the percentage of patient IDs and medications scanned were well above expectations. During the following months, the percentages continued to rise.

ÒWe have already exceeded our initial objectives of achieving full implementation of the complex BCMA system, and we are well ahead of the curve when compared to other hospitals that have initiated BCMA,Ó reported the HospitalÕs Medical Safety Officer Jen Huang, PharmD. ÒOur success is due to hard work, meticulous preparation and the high level of teamwork that exists at this hospital. In the end, it makes medication administration at Washington Hospital even safer, which benefits our patients and the entire community.Ó

Learn more

For more information about Washington Hospital, go to www.whhs.com. To receive a copy of the Washington Hospital Healthcare SystemÕs 2012-2013 Annual Report, call (510) 791-3417.